Bruises can hide a deadly secret

A bruise means that a child is just rambunctious, right?

A bruise means that a child is just rambunctious, right?

Possibly, but some bruising can signify something much more serious: child abuse.

“Bruises are the most overlooked sign of abuse,” said Stephen A. Wright, M.D., medical director of Norton Children’s Hospital and chair of the Partnership to Eliminate Child Abuse. “A huge myth is that this bruising is obvious and matches the size of an adult hand. The reality is that serious conditions that occur as a result of abuse are often indicated by small, subtle bruises.”

Kentucky has consistently ranked as one of the worst states in the country for child abuse and deaths caused by child abuse. Every day, there is a child at Norton Children’s Hospital who is a victim of abuse. Almost every week, there is at least one child who has been injured so severely that he or she requires care in the hospital’s “Just for Kids” Critical Care Center.

A group of researchers that included Justine O’Flynn, R.N., who works in the “Just for Kids” Critical Care Center at Norton Children’s Hospital, discovered what they call the TEN-4 bruising rule.

“Infants who are 4 months old and younger should not have any bruising anywhere,” O’Flynn said. “And children ages 4 years and younger should not have any bruising on the torso, ears or neck. If your child or a child you know has bruises that fall into these categories, he or she needs to be seen immediately in the emergency department.”

Sound serious? It is. Pediatric experts have found that even small bruises can mean big problems.

“Bruises don’t have to be large in order to be significant — much depends on their location on the body,” said Melissa L. Currie, M.D., director of the Norton Charities Division of Pediatric Forensic Medicine at the University of Louisville. “Even a small bruise on an infant’s stomach could be the only indication that there is an underlying liver laceration that has occurred because the child was punched in the stomach. And ears do not bruise easily, so when we see a bruise in this location we know to look carefully for additional trauma to the head.”

“If you’re at all concerned, you should seek medical attention for your child,” Dr. Wright said. “Wouldn’t you rather be wrong and have played it safe?”

We all can play a part in preventing child abuse. To learn what you can do to raise awareness among families you know and members of your community, visit Preventing child abuse

What is normal bruising?

For toddlers and older children, bruises usually occur on the front of the body and over bony areas such as the forehead, elbows, knees and shins.

Preventing Child Abuse

One of the factors that increases the chance of abuse is having an unrelated man, such as a boyfriend or acquaintance, take care of a child. In addition, avoid leaving a child with someone who uses drugs, has anger management issues, is violent and/or does not understand child development, especially if the child is younger than 4 years old or has special health care needs. Spend time with the people who are caregivers of your children. Watch how your child reacts to them and how they react to your child.

Caregivers with unrealistic expectations for the child in their care can become frustrated more easily when the child cannot live up to those expectations. For example, most children are unable to stop crying on demand before 4 to 5 years old.

“Babies cry. They may cry because they are tired, hungry or need their diaper changed. They use crying to communicate,” Dr. Wright said. “Toddlers may cry because they don’t know how to tell you what they want or they’re frustrated. Babies and kids may even cry for no apparent reason. It’s important to remember that they don’t cry to be bad or make you angry.”

If you find yourself becoming frustrated, it is OK to take a break. Put the baby in a safe place and step away for a few minutes. Take a few deep breaths, listen to your favorite song or do a few exercises. You can also call a trusted friend or relative or the Childhelp National Child Abuse Hotline at (800) 4-A-CHILD/(800) 422-4453.

To make a confidential, anonymous report: In Kentucky, call the Kentucky Child Protection Hotline toll-free 24/7 at (877) KYSAFE1. In Indiana, call the Indiana Child Abuse and Neglect Hotline toll-free 24/7 at (800) 800-5556.

New bill aims to help detect early signs of child abuse

In late April, Kentucky Gov. Steve Beshear signed House Bill 157, which requires training in the recognition and prevention of pediatric abusive head trauma and signs of child abuse for doctors who are likely to see children: pediatricians, radiologists, family practitioners and emergency medicine and urgent care physicians.

Caregivers at Norton Children’s Hospital have found that more than 50 percent of children who are killed or nearly killed from child abuse had seen a medical professional within two weeks before their death or hospitalization.

Legislation passed in 2010 required similar training for all other health care professionals, social workers, daycare employees and police to undergo similar training. The new mandatory physician training is available free of charge at


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